Child Health: A fair start in life >> Patterns and risks of child mortality narrowing the gaps between rich and poor countries is one of the defining challenges of our time. The starting point for achieving that outcome in child survival is to work towards bringing mortality rates among the poorest to the levels of the wealthiest within countries. Prospects for the survival and good health of all children in every society, rich and poor, should advance as quickly as possible. But the prospects of the children left furthest behind need the most rapid improvement. in other words, accelerated gains must be achieved among those facing the highest risks of death and disease. an effective approach to this challenge will have to address the wider social determinants of inequity, including poverty, discrimination and unequal access to basic services. Patterns and risks of child mortality for approximately 1 million children in 2015, their first day of life was also their last. Globally, the neonatal mortality rate (probability of dying during the first 28 days of life) is declining less rapidly than the mortality rate for children between 1 month and 5 years of age. This means that the share of under-five deaths occurring during the neonatal period is increasing. in 2015, neonatal deaths accounted for 45 per 16 cent of total deaths, 5 per cent more than in 2000. The rising share of deaths in the neonatal period reflects the faster decline in The Share of Under-fiVe mortality of children aged 1 to 59 months than of newborns. Still, of the 5.9 deaThS oCCUrrinG dUrinG million under-five deaths in 2015, almost half were caused by infectious diseases The neonaTal Period iS and conditions such as pneumonia, diarrhoea, malaria, meningitis, tetanus, inCreaSinG. measles, sepsis and aidS. Pneumonia and diarrhoea remain leading causes of death in the three regions with the highest under-five mortality: eastern and Southern africa, South asia and West and Central africa. The burdens of both disease and mortality are often highest among the most disadvantaged.17 There are marked regional variations around the broad neonatal trend. in sub-Saharan africa, newborn deaths account for about one third of the deaths of children under age 5. in regions with lower levels of child mortality, neonatal deaths comprise approximately half of the total. South asia, on the other hand, 18 has both high overall child mortality and a high share of neonatal deaths. The geographical distribution of the burden of child mortality is also changing. Globally, child deaths are highly concentrated. in 2015, about 80 per cent of these deaths occurred in South asia and sub-Saharan africa, and almost half occurred in just five countries: the democratic republic of the Congo, ethiopia, india, nigeria and Pakistan.19 Children living in fragile states and conflict-affected countries face elevated risks. according to the World development report 2011, they are more than twice as likely to be undernourished as children in low- and middle-income 20 countries, and twice as likely to die before age 5. among the 20 countries with the highest child mortality rates, 10 fall into the World Bank’s list of fragile contexts.21 in countries affected by conflict, damage to health systems threatens children’s lives. The Syrian arab republic, for instance, had made impressive progress in reducing under-five mortality prior to the current conflict there. Since 1990, the rate fell from 37 to 13 deaths per 1,000 live births. Since 2012, however, the country’s excess crisis mortality – that is, the under-five mortality attributable to crisis 22 conditions – has been an estimated one to two deaths per 1,000 live births. The STaTe of The World’S Children 2016 10